The global battle to contain the novel coronavirus disease 2019 (COVID-19) pandemic rages on. Previous studies described the clinical characteristics of COVID-19, but knowledge gaps remain in the Middle East region. Identifying these features will help in mapping the disease and guiding pandemic management. A multi-center, retrospective cross-sectional study was initiated to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases across all the regions of Saudi Arabia. The analysis included all laboratory-confirmed positive COVID-19 patients from the 1st of March 2020 to 31st of March 2020 across all regions of Saudi Arabia. Demographic data, clinical characteristics, incubation periods, laboratory findings, and patient outcomes data were retrieved from 1519 cases in the Health Electronic Surveillance Network Database. The median age was 36 years and 54.3% (n = 825) of the patients were men. Patients working in health care facilities represented 12.5% of the cases (n = 190) and 9.3% of cases were asymptomatic. The median incubation period was 6 days. The most common symptoms were cough (89.4%), fever (85.6%), and sore throat (81.6%); 20.1% of the patients had underlying comorbidities. Hypertension was seen in 8.8% and diabetes in 7.6% of all the cases. The percentage of cases with temperatures >38֯C was 20.3% (n = 129), and 1.6% of patients had heart rates ≥125 beats/min and 4.7% of them had respiratory rates of >24 breaths/min. Lymphocytopenia occurred in 37.5% of cases. Overall, 71.6% of patients were admitted to hospitals and 4.7% required ICU treatment. We could not completely assess the clinical courses or final outcomes of COVID-19 patients. In this multi-center retrospective study, fever and cough were common symptoms. Special attention should be addressed toward asymptomatic carriers and workers in health care facilities as they play a key role in disease transmission.

Objectives: Assess the survival of hospitalized coronavirus disease 2019 (COVID-19) patients across age groups, sex, use of mechanical ventilators (MVs), nationality, and intensive care unit (ICU) admission in the Kingdom of Saudi Arabia. Methods: Data were retrieved from the Saudi Ministry of Health (MoH) between 1 March and 29 May 2020. Kaplan–Meier (KM) analyses and multiple Cox proportional-hazards regression were conducted to assess the survival of hospitalized COVID-19 patients from hospital admission to discharge (censored) or death. Micro-costing was used to estimate the direct medical costs associated with hospitalization per patient. Results: The number of included patients with complete status (discharge or death) was 1422. The overall 14-day survival was 0.699 (95%CI: 0.652–0.741). Older adults (>70 years) (HR = 5.00, 95%CI = 2.83–8.91), patients on MVs (5.39, 3.83–7.64), non-Saudi patients (1.37, 1.01–1.89), and ICU admission (2.09, 1.49–2.93) were associated with a high risk of mortality. The mean cost per patient (in SAR) for those admitted to the general Medical Ward (GMW) and ICU was 42,704.49 ± 29,811.25 and 79,418.30 ± 55,647.69, respectively. Conclusion: The high hospitalization costs for COVID-19 patients represents a significant public health challenge. Efficient allocation of healthcare resources cannot be emphasized enough.

The Hajj mass gathering is attended by over two million Muslims each year, many of whom are elderly and have underlying health conditions. Data on the number of pilgrims with health conditions would assist public health planning and improve health services delivery at the event. We carried out a systematic review of literature based on structured search in the MEDLINE/PubMed, SCOPUS and CINAHL databases, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to estimate the prevalence of diabetes and hypertension among Hajj pilgrims. Twenty-six studies conducted between 1993 and 2018 with a total of 285,467 participants were included in the review. The weighted pooled prevalence rates of hypertension and diabetes among Hajj pilgrims in all included studies were 12.2% (95% CI: 12.0–12.3) and 5.0% (95% CI: 4.9–5.1), respectively. The reported prevalence of other underlying health conditions such as chronic respiratory, kidney or liver disease, cardiovascular disease, cancer and immune deficiency were generally low. Potentially a large number of pilgrims each Hajj have diabetes and/or hypertension and other underlying health conditions. Hajj could be a great opportunity to reduce the burden of these diseases within the over 180 countries participating in the event by identifying undiagnosed cases and optimizing patients’ knowledge and management of their conditions. Prospero registration number: CRD42020171082.

The Hajj pilgrimage, held in the Kingdom of Saudi Arabia, is among the largest mass gatherings in the world. More than 2.5 million Muslim pilgrims assemble from over 180 countries worldwide to perform Hajj. The Saudi government recognized the potential risks associated with this event since the first novel coronavirus disease 2019 (COVID-19) case was detected in the country on March 2, 2020. The return of possibly infected pilgrims to their countries after this huge mass gathering event could have turned Hajj into a superspreading event during the global COVID-19 pandemic. A multidisciplinary Saudi team from governmental sectors, including the Global Center for Mass Gatherings Medicine, shared in the assessment, planning, execution, and success of this holy event to prevent the spread of disease. The World Health Organization welcomed the Saudi government's decision to protect the wellbeing and safety of pilgrims and strengthen regional and global health security. A total of 1,000 pilgrims from 160 different countries were randomly selected to perform the rituals. Of all the pilgrims, healthcare personnel, and nonmedical employees facilitating the rituals, no confirmed cases of COVID-19 were identified during or after Hajj. This article highlights the success of the risk mitigation plan in place during the Hajj pilgrimage in 2020 (1441 Hijri year) during the COVID-19 pandemic and the efforts of the Saudi government to prevent associated outbreaks.

The aim of this study is to describe the clinical and demographic characteristics of COVID-19 patients, and the risk factors associated with death in Saudi Arabia to serve as a reference to further understand this pandemic and to help in the future decisions and control of this global crisis. This multicenter, retrospective, observational, cross-sectional study was conducted on 240,474 patients with confirmed COVID-19 in Saudi Arabia. Data was collected retrospectively through the Health Electronic Surveillance Network at the Ministry of Health. Patients were classified based on their outcome as recovered, dead, or active with no definite outcome. We must specify the date period. As of 20th of June 2020, 79.7% of COVID-19 cases were young and middle-aged, ranging between 20–59 years. There was evidently a difference in the sex ratio, where males constituted 71.7% of cases. The majority were non-Saudi nationals, representing 54.7% of cases. Furthermore, the contraction of COVID-19 was travel-related in 45.1% of cases. Signs and symptoms were reported in 63% of cases, the most common of which were fever; 85.2%, and cough; 85%. Deaths occurred more frequently in patients 40−49 years, 50−59 years, and 60−69 years, representing 19.2%, 27.9%, and 21.3% of deaths, respectively. Additionally, the case fatality rate (CFR) was higher in older age-groups, reaching 10.1% in those ≥80 years. Moreover, the CFR of males was higher than that of females, with 0.95% and 0.62%, respectively. As for nationality, Saudis had a CFR of 0.46% versus 1.19% in non-Saudis. The total number of positive COVID-19 cases detected constitute 0.7% of the Saudi population to date. Older age, non-Saudi nationalities, being male, travelling outside Saudi Arabia, and the presence of symptoms, as opposed to being asymptomatic were considered risk factors and found to be significantly more associated with death in patients with COVID-19.

Climate change is the most challenging natural calamity of chronic nature that presents intense episodes of heat waves, and events. Effects of heat waves and increasing average temperature on heat-related illnesses (HRIs) demand a review of existing preventive and treatment strategies to direct future research. Heat-related illnesses are presented as minor to severe life-threatening conditions. Despite the understanding of the pathophysiology of HRI, pharmacological interventions are limited. Prevention is the best strategy against HRI. There is a dearth of epidemiological studies that reviewed the effect of pharmacological interventions on mortality, and there remains a need to identify critical key components other than inflammatory modulators, which can be targeted to decrease HRI.